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在前交叉韧带重建术后,手术侧和未手术侧膝关节的神经肌肉控制受损可持续至术后1年。

Impaired neuromuscular control up to postoperative 1 year in operated and nonoperated knees after anterior cruciate ligament reconstruction.

作者信息

Lee Jin Hyuck, Han Seung-Beom, Park Jong-Hoon, Choi Jae-Hyuk, Suh Dae Keun, Jang Ki-Mo

机构信息

Department of Sports Medical Center.

Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.

出版信息

Medicine (Baltimore). 2019 Apr;98(15):e15124. doi: 10.1097/MD.0000000000015124.

Abstract

The current study was performed to assess serial changes in neuromuscular control until 1 year postoperatively in nonathletic patients undergoing anterior cruciate ligament reconstruction (ACLR).Ninety-six patients were included. Serial neuromuscular control tests were performed preoperatively, at 6 months, and 1 year postoperatively. Neuromuscular control was evaluated using acceleration time (AT) and dynamic postural stability (overall stability index, OSI). Functional activity levels were assessed using the Tegner activity-level scale.Preoperative AT of quadriceps and hamstrings in operated knees was 78.9 ± 6.4 and 86.5 ± 6.2 ms, respectively, which significantly reduced to 56.9 ± 2.0 and 62.5 ± 2.8 ms at 1 year (P = 0.006 and 0.002, respectively). In nonoperated knees, preoperative AT of quadriceps and hamstrings was 47.6 ± 1.7 and 56.5 ± 1.7 ms, respectively, which was significantly prolonged to 54.3 ± 2.0 and 67.9 ± 2.7 ms at 1 year (P = 0.02 and 0.001, respectively). Preoperative OSI of nonoperated knees was 1.2 ± 0.0°. It significantly increased to 1.5 ± 0.1° at 1 year (P < 0.001). In operated knees, preoperative OSI was 1.8 ± 0.1°. It significantly decreased to 1.4 ± 0.1° at 1 year (P = 0.001). Tegner scale at 6 months and 1 year were significantly lower than pre-operative scale (P < 0.001). AT and OSI on both knees showed significant negative correlation with Tegner scale at 6 months and 1 year.Neuromuscular control in both knees was not restored to preoperative levels of the nonoperated knees until 1 year after ACLR. Therefore, clinicians and physical therapists should attempt to enhance neuromuscular control in both nonoperated and operated knees.

摘要

本研究旨在评估非运动员患者前交叉韧带重建术(ACLR)后1年内神经肌肉控制的系列变化。纳入了96例患者。在术前、术后6个月和1年进行了系列神经肌肉控制测试。使用加速时间(AT)和动态姿势稳定性(整体稳定性指数,OSI)评估神经肌肉控制。使用Tegner活动水平量表评估功能活动水平。手术侧膝关节术前股四头肌和腘绳肌的AT分别为78.9±6.4和86.5±6.2毫秒,1年时显著降至56.9±2.0和62.5±2.8毫秒(P分别为0.006和0.002)。在非手术侧膝关节,术前股四头肌和腘绳肌的AT分别为47.6±1.7和56.5±1.7毫秒,1年时显著延长至54.3±2.0和67.9±2.7毫秒(P分别为0.02和0.001)。非手术侧膝关节术前OSI为1.2±0.0°。1年时显著增加至1.5±0.1°(P<0.001)。在手术侧膝关节,术前OSI为1.8±0.1°。1年时显著降至1.4±0.1°(P=0.001)。6个月和1年时的Tegner量表显著低于术前量表(P<0.001)。6个月和1年时双膝的AT和OSI与Tegner量表均呈显著负相关。ACLR术后1年,双膝的神经肌肉控制均未恢复到非手术侧膝关节的术前水平。因此,临床医生和物理治疗师应尝试增强非手术侧和手术侧膝关节的神经肌肉控制。

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